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Deeper Perception Made Practical

Which is harder, suicide or qualifying to receive psychiatric medication? A guest post by Kira

A mind-body-spirit celebration of all true medicine

In my work, I am able to help some clients make remarkable progress toward their emotional and spiritual goals. But what about folks who also need help, short-term or long-term, with psychiatric medications?

Part of your personal development, Blog-Buddies, is deciding for yourself how you will relate to medicine. Is there one “Evolved way,” far superior to the “Sad, un-evolved ways”?

What heals? And if your life depended on healing, what would you choose?

This is such a charged topic, especially if you have ever, in this lifetime, personally dealt with significant mental health issues.

Another tricky scenario would have happened if, as a person of faith or a New Ager,  you have gone through significant physical health issues demanding medical attention. Such was the case recently for Blog-Buddy HERMIONE, who wrote Does New Age have to be anti-medicine? A guest post by Hermione. Another guest poster, DAVE, had written about health choices in How Energetic Literacy helps me accept reality, a Guest Post by DAVE.

Both guest posts resulted in prolific and passionate comments here at “Deeper Perception Made Practical.” Off-blog, I have often had conversations about the value, and limitations, of Rosetree Energy Spirituality for helping those with mental health problems, including:

  • One session with a new client, just this month, whom I told part-way into our session, “Unfortunately I am not qualified to help you. Please seek out a psychiatrist as soon as possible.”
  • One session with an established client, just this month whom I referred to a clinical psychologist so that she could double track, having sessions with each of us for the near future.
  • One session with an established client fighting her way back from another serious revisit of bipolar problems, where medication didn’t prevent half a year of extreme dysfunction, although she is stable now and I was able to help her to move forward.
  • Conversations and email exchanges with students of mine who are mental health professionals, valuing Rosetree Energy Spirituality and learning how to sort out which skill set helps best with what.

This is no tiny topic. Don’t you know at least one person who takes medication for depression, anxiety, insomnia, etc.?

Now that collective consciousness has improved related to rights of LGBTQ, I sure would love for the next group to receive collective respect to be…

those who have suffered mental health problems. As if that were, in any way, shameful!

Here is a lovely guest post, appropriately proud, from Blog-Buddy Kira. I added some links, copy edits, headings. And now, applause for her courage.

Can mental health problems really be so very common now?

HERMIONE, in Comment 8, you said:

“Who knows what the people who take anti-depressants are dealing with. Maybe a lot of them need to deal with this kind of insecurity. If it helps them cope and balances their brain chemistry, who are we to judge?”

I can only wonder what people who take antidepressants currently have to deal with, and I’m only talking about getting the proper help, not people’s attitudes.

I first started taking Prozac in 1994. Up to that point, I was extremely leery of antidepressants, but my closest friend knew someone on Prozac and reassured me that he was still himself, only not depressed.

By this time,  I was suicidal and within 4 points of maxing out the Beck Depression Inventory Score, so I knew I had to do something.

Which is harder, suicide or qualifying to receive psychiatric medication?

I can tell you that it almost certainly would have been actually easier to kill myself than to go thru the hoops I went thru to get coverage for the psychiatrist visits and medication.

Right now, looking back on it with my current frame of mind, it doesn’t seem like a very big deal at all. I needed to make a toll-free call to the proper number on my insurance card, and then had to call another number given to me by the first person I talked to.

The second person needed some information about why I wanted to see someone, part of which consisted of, “Have you ever attempted suicide?”

Ultimately, I was assigned a doctor and everything was covered.

But look at it from the frame of mind I had back then.

I was extremely depressed.

I had an actual suicide plan.

What is the only reason  I didn’t carry it out?

Because of my conversation with my friend, who made it clear that my dying would hurt her a great deal and that my being so depressed also hurt her.

In addition to the general frame of mind, I hated making phone calls to strangers. I even tended to agonize over making phone calls to friends.

The courage it can take to live, and to seek help

It was a nearly insurmountable task to make that first phone call, but I was desperate.

Then I had to make another one, to someone else.  I had to talk about how I was feeling to a total stranger who wasn’t a therapist (as far as I knew).

And I had to tell this person that yes, I had attempted suicide.

Then she needed to hear the details.

My attempt at suicide had actually been embarrassingly bad.

I remember trying to figure out if I could still get coverage if I didn’t admit to the suicide attempt.

Mind you, at this point, I’d already had several therapists (none of them psychiatrists because I was hoping not to need medication). With these therapists, I couldn’t bring myself to tell a single one of them about my suicide attempt. (I think they were covered pre-HMO and didn’t need details.)

The horrible struggles some of us go through, begging for help with mental health problems

Yeah, I hope it hasn’t gotten any worse than that, but I wouldn’t be surprised if it has.

On the plus side (sort of), I eventually got to the point where I could just recite the suicide attempt details.

You see, it turned out that every time I finished the prescribed course of therapy and found myself needing yet another round, guess what?

There was always an end point for my mental health coverage.. This required new authorization before more services would be covered.

Suicide attempt story? I had to go over it yet again.

 

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  1. 1
    Chuckles says:

    Geesh, how fair is that?

    Imagine if every guy who wanted a prescription for Viagra had to go into lllllllavish detail with doctors about every episode of erectile dysfunction.

  2. 2
    Madeline says:

    Thanks Kira for sharing your story. I think its important for those who haven’t suffered from severe depression to know how difficult even the most seemingly simple task can be.
    Your courage in sharing your story will create more compassion.

  3. 3
    Katie says:

    I am sorry for your pain dear Kira, and I applaud your courage for sharing your story, and for keeping yourself alive during the very difficult time you had seeking help. I am often dismayed at how our health care system fails those who are suffering — especially those with psychiatric illness who are at their most vulnerable during an acute episode. It is outrageous that you are asked to repeat your story endlessly each time you are in need of care, at the time when you are least able to advocate for yourself.

    To that end, knowing that HMOs are infamous for perfecting barriers to coverage (although the federal mental health parity act and its recently issued final regulations should improve mental health benefits overall,) if you are reliant on an HMO to fund your care, it might be a good idea if possible to develop a relationship with a therapist and a psychiatrist in your network while you are not in an acute episode, to help make access easier in the future.

    I wholeheartedly endorse Rose’s desire to see collective respect develop for those with mental health struggles. Just as for physical suffering, treatment of some form is essential, and sometimes optimally includes medication. For many, psychiatric medication can support healing, and can improve functioning in your human life. These medications – like any medications for any medical condition – don’t always help, and if they do, they sometimes have disabling adverse effects that prevent them from being a reasonable treatment option. Otherwise, why not use psychiatric medication as a tool, with discernment, in partnership with a health care professional with whom you have developed a relationship of mutual respect? For any length of time that is helpful, short-term or long-term? Using psychiatric medication along with a new age modality of treatment such as Rosetree Energy Spirituality may provide the best treatment possible for many types of psychiatric illness.

  4. 4
    David.. says:

    Wow – thanks for the open honesty, Kira. It’s by sharing such stories that other people can more easily understand. Although I fully appreciate some won’t want to hear.

    It also makes me appreciate being Canadian. In such a circumstance, I simply need a doctors referral. So I’d have to talk to the GP about it, then the mental health pro. Both pros, not insurance gateways.

    But even that can’t be easy. As Rose observes, there really is a stigma.

    My own experience has mostly been in aging family members. It’s surprising what memory going off-line effects. And how that slows adaptation and increases stress.

  5. 5
    Kira says:

    Thank you all for your kind comments.

    The insurance situation did eventually improve, but that could well have had more to do with switching to a PPO from an HMO (and also switching insurance companies in the process) than with changing times.

    I was on Prozac for several years (I don’t remember exactly how long any more without my medical history notes), then tapered off under my psychiatrist’s supervision. I started thinking about needing medication again after 9/11/01, but I had a job operating heavy machinery, and SSRI and related antidepressants are one class of drugs that carry the “Use care when operating heavy machinery” label. I wound up actually going back on medication in either 2002 or 2003, after I was laid off from that job.

    The second time around, my primary care physician could prescribe it, because I had previously been diagnosed with depression. And by that time, I was somewhat of a self-taught expert on which drugs had which side effects, so we worked together to figure out what I should take. It was a much better process. I don’t know if I would still have needed a psychiatrist to diagnose me and prescribe it if I hadn’t already had a documented history. Under a PPO instead of an HMO, I might also have only needed my PCP’s referral.

    I just have to wonder how many people (if any) never made it all the way through the HMO process.

  6. 6
    Hermione says:

    KIRA, thank you for bravely sharing your story. I’m glad that you were able to keep finding the courage to get your needs met in the face of the bureaucratic ridiculousness.

    I think that it’s important that people become aware of the realities faced in these situations. Of course, many people don’t want to know, but again, in the face of sweeping statements that seem to be all the rage these days, it’s important to make a statement that is clearly based in one individual’s reality. I know that for me, it’s empowering and just helps me feel better to tell my version of that kind of situation. I hope you might have experienced something like that, too, in sharing your story.

    I can see how a well-developed sense of humor helps in dealing with such absurdity, once the worst has passed. I like Chuckles’ idea about Viagra. 🙂

    I was thinking about the links ROSE shared in another thread about the huge increase in psychiatric medications in the U.S.

    I wonder how many of the people in that increase are having to deal with challenges from the current health care system.

    I’ve dealt with a lot in my life, big challenges, nasty people, etc. Maybe it’s cause I’m still in the thick of it all with health issues, but I don’t think so.

    I’d guess that most sane people would agree that tying a health care system to profit is crazy. I sure did.

    But it wasn’t till I had to be in those conversations in which the insurance co. guy X,Y, or Z made it real clear in a variety of ways that my health was of no concern whatsoever. This is all business, dollars and cents, make no mistake. No humanity there to be connected with. If that test would have a huge impact on my health, oh well, he didn’t care. And he wasn’t even correct in his assertion that it wasn’t covered. He wasn’t even going to try to help me.

    I’ve dealt with some seriously nasty folks in my day, but nothing has been more chilling than the dealings I’ve had with folks at my insurance co.

    As my Danish hairdresser and I were discussing yesterday, how can the richest planet on earth choose not to take care of its people? And the way things have been going, how can those powerful politicians who do so fight to continue not to take care of America’s people? Such nastiness to deal with….

    In Denmark, the happiest country on earth, everyone has complete health care, cradle to grave. It is a cultural decision that has been made that taking care of each other is important. Of course, Denmark is a small country, but it’s that decision about how a culture chooses to deal with its people that is key, IMHO.

    And the way things are rolling in the U.S., it would be no surprise to me that lots more people are taking anti-depressants!

    Because it’s a chilling experience to come face-to-face with that American cultural decision, as it stands now, and as it plays out in individual lives.

  7. 7
    Kira says:

    HERMIONE, it’s not just healthcare, either. There are bureaucratic hurdles to getting welfare, too. One of my friends manages to enroll sometimes, but is also often turned down or delayed in getting benefits due to forms forgotten or filled out incorrectly. His personal hypothesis is that the bureaucratic hurdles are there to prevent abuse of the system, but that the hurdles are such that the abusers of the system are the ones who best know how to navigate them.

    To move back toward the topic, he doesn’t have any insurance, not even Medicaid; I’m not sure if he doesn’t qualify or just can’t overcome the bureaucratic hurdles. He is on an antidepressant and a diabetes medication.

    At the time he started on the antidepressant, I believe his primary care physician was able to prescribe it to him, even without a previous diagnosis, which I had forgotten about when thinking about my own situation. But he probably can’t afford to buy the proper dosage. For all I know, he might have stopped taking it entirely.

    He can afford the diabetes medication only because our regional grocery store chain (Giant Eagle) makes certain medications available for free.

    I am not at all happy about how we treat low-income people in our country. But even if it were okay to ignore the needs of people who can’t afford healthcare, you might expect that insurance companies should treat paying customers better than ours treated us.

  8. 8
    Call me someone one else says:

    Kira, thank you for having the courage to share your story. My family has pitched in, in various ways to help one of my brothers deal with depression and mental health issues combined with severe physical/medical issues.

    It’s kind of a mess, but then life gets that way sometimes, but he does seem to be getting better very, very slowly on the physical/medical part.

    He had limited access to mental health doctors/medications when he lived out west (insurance he had was not great and didn’t pay anything for visits and he was unemployed) before July 2013, but he wasn’t or couldn’t advocate for himself and it was a real scary scenario. My sister in law who is a nurse went and physically brought him east where all his family is.

    So we got him to the hospital for the physical/medical part and got all his doctor’s lined up for all aspects of his care. (3 hospital stays, total of 13 weeks).

    He was trying to take care of himself but didn’t seem to have the capacity. This is someone who for the last 20 years had a high profile job.

    So now all his doctors are lined up, including the mental health piece, and hopefully he will be able to improve, but it is a very, very slow process and actually I don’t ever see him returning to who he used to be, or who he projected himself to be. This has been an eye opener for our family because we’ve never dealt with any type of mental illness.

  9. 9
    Kira says:

    Someone Else, your brother is lucky to have family to help him. My family would have helped me, but it was extremely important to me to hide from them just how bad I felt. (More on that in a minute.)

    My low-income friend has 2 brothers and 2 sisters, and only 1 brother ever helps him in any way. And that brother has to hide from his wife any contact with my friend.

    I hope your brother keeps improving.

  10. 10
    Kira says:

    Back to why I hid my depression from my family: I sensed they would blame themselves somehow. I’m an only child, so it was primarily my parents I was hiding it from. My husband was aware of it, but I didn’t talk about it much with him because I knew it hurt him to see me unhappy.

    My current working hypothesis is that if I had had either Empowered by Empathy or Become the Most Important Person in the Room, I might never have needed medication in the first place. But the medication definitely helped.

  11. 11

    KIRA, this is a poignant observation:

    “My current working hypothesis is that if I had had either Empowered by Empathy or Become the Most Important Person in the Room, I might never have needed medication in the first place.”

    I do encourage all you Blog-Buddies to tell friends and family members who might be helped by developing Empath Empowerment.

  12. 12

    Thanks so much for all the comments so far on this thread from you Blog-Buddies.

    I particularly wish to flag the sound practical advice from KATIE in Comment 3.

    And with most of these comments, wow! So many could have been made into Guest Posts — all that detail, heartfelt concern, wisdom.

    All you Blog-Buddies are The Best!

  13. 13
    Call me someone one else says:

    Kira; Good point about hiding it from the family. My brother did this we think, for about 6 years. Living out west there were phone calls, everything’s great, etc. etc., I know the right job is coming along… visits home at Christmas for a week or less.

    It was apparent when all this hit the fan in July of this year, the enormity of what he’d been hiding from everyone. My sister in law who brought him back, basically picked up his life from out west, cleared up the essentials and transferred him and his clothes here. She cleared all his stuff out from where he was staying, even his friends had been enabling him, hoping he’d get well. He put up a good front while sliding further down the hole.

    She could tell from when he basically started tossing his bills on the floor of his room, when it really got bad.

  14. 14
    David.. says:

    Agree with Rose on comment 11. This is a key observation. With the right understanding and approach to life and our gifts, life is much more smooth. When we struggle against life due to wrong understanding, not so much.

  15. 15
    Primmie says:

    Kira, just wanted to say that as a parent (a newish one as I have toddlers) I’d always always want to know if my children were going through what you’ve been through. And if I blamed myself with all my heart and that was tough for me, I’d still want to know. Parents can take blaming themselves. I think I might struggle much more with knowing that a beloved child of mine was going through something horrendous and was keeping it from me to protect my feelings. Love to you for all you’ve been through.

  16. 16
    Kira says:

    In reference to comments 11 and 14, I had no idea there was such a thing as an empath when I first started feeling suicidal in high school. I knew the science-fictional or fantasy version of the concept (even though this was before Deanna Troi) but didn’t think it existed in real life. Even so, when my high school counselor told me (after correctly surmising that I didn’t really want a body) that I should try empathy, my inner response was, “Wait, WHAT?” I knew intuitively that I was suffering more from too much empathy than not enough.

  17. 17
    Kira says:

    Primmie, thank you.

    It wasn’t just wanting to spare their feelings that motivated me to hide the depth of my depression from my parents. There were all kinds of reasons, some of which were better than others. I was also going by an intuitive sense of what they might feel–I never talked to them about it, so I don’t even know if I was right. It wasn’t until years later that I figured out that worry about their guilt feelings had anything to do with it. It was literally unthinkable for me to talk to them about it. I would feel sick whenever I attempted to figure out what was so bad about their knowing.

    I did let them know I was on medication, and I let them know when I went off the medication, back on, and back off again.

  18. 18
    Kira says:

    Oh, and not talking to my parents about being suicidal may not have been the right decision. It just happens to be the one I made.

  19. 19
    Primmie says:

    Kira, it sounds to me like you made the best decision for you at that time. It’s only now that I am a parent that I realise how much I would want to know if my children were in distress, I wasn’t in touch with that at all before I was a mother. Also, I’m going to have to accept that as my children become adults there will most likely be lots of things that they will want to keep private from me.

  20. 20
    Kira says:

    Primmie, that’s so understandable.

    I know my mother was hurt by the fact that I didn’t like to confide in her, but I did have friends who confided in her, and I think that helped some. I was different enough from my parents–in personality type and in being highly sensitive–that I used to fantasize as a child about having been adopted and someday going to find my “real” parents. I guess I felt misunderstood. I hope your children never feel that way.

    I get along with them a lot better now. They yell a lot–at each other, at me; it’s not deep-seated anger, just the way they communicate–and just this year, for the first time, I spent time with them and none of my buttons were actually pushed. I even caught myself laughing at something that in previous years probably would have had me hiding tears.

  21. 21
    Zelda says:

    I had one of those “restore my faith in humanity” moments today. What a boost it gave me!

    As we’ve been discussing, there are organizations and people who could make such a huge, positive impact on lives every day in these various health care settings, but with rules, protocols, and profit motivation driving their behavior, it can turn into anything but a huge, positive impact.

    I am a bit worn out from those kinds of dealings lately.

    So after transferring trains on my commute today, I realized that most likely my iPhone had slipped out of my coat pocket on that first train.

    I figured it was basically gone. Oy.

    When I spoke to the station agent at the last stop, she told me that people drop off phones and wallets every day. She’d just gotten a wallet with $700 cash in it!

    Later in the day, I found an email from the woman who found my phone. She works not far from where I live, so I can go pick it up in the morning. Whew!

    It really made my day that she did this.

  22. 22
    Kira says:

    That’s awesome, Zelda!

  23. 23
    Primmie says:

    Kira, I also find things are much easier these days with my parents. It’s lovely to be able to laugh at things that would have really haunted me in the past.

    Hmm, I wish I could say with confidence that my children won’t feel misunderstood, but I can’t. Two children who understand language without being able to speak it, is making for quite a wild time of misunderstanding in our house right now, as well as moments of pure joy when communication actually works.

  24. 24
    David.. says:

    Hi Primmie
    Yeah, I have 2 young adult children now. It’s common for kids to go through a pulling away from parents in the teens. To establish their own identity. The degree of that depends on the individuals and the dominance of personalities.

    It’s really nice when they again seek to reconnect again. My guys never disconnected but they didn’t share much for awhile.

    If there is also high levels of personal stress at that time of life… worries about others involvement, perceptions, control, and/or upset, it could tend to amplify this division. They want their own space to work it out even if they’re not succeeding. Otherwise,there can be a sense of failure at becoming “adult”.

  25. 25
    David.. says:

    I was really happy when my guys got to be old enough to have conversations. 😉

    Still amazed at their insights and perspective.

  26. 26
    Zelda says:

    Thanks, KIRA. 🙂

    Today I went over to this angel’s office with some flowers to thank her and we had a lovely moment of celebrating human kindness and thoughtfulness.

    Of all the possibilities of places she could live or work in the metro area I live in, her office is a 10-minute drive from my home.

  27. 27
    Kira says:

    I have 2 nieces and will soon have a nephew (early next year). I’m looking forward to being able to have conversations with them. The oldest is almost old enough. I’ll be visiting them for Christmas.

  28. 28
    "A Psychiatrist Who Also Reads Auras" says:

    If this kind of problem can happen at Harvard, it could happen anywhere.

    http://thedrugsdontworkdiscoverwhatdoes.blogspot.com/2012/12/students-complaints-about-mental-health.html

  29. 29
    Kira says:

    I went to Rice, but I too had issues with the system. The first therapist I saw was the head of Rice’s psychiatric services. He didn’t seem to make any attempts to draw out what was bothering me, and I had a deeply ingrained habit of hiding things that bothered me. He decided I wasn’t actually depressed. The fact that I was often fantasizing about suicide never came up; I was terrified of being committed to a mental facility if I told him that. But I was dumbfounded that he couldn’t just look in my eyes and see the torment inside. (I did my best to break my habit of never looking anyone in the eye enough so he could see me directly.) It never occurred to me that not everyone can do that.

    I went back several times, probably once per school year, each time getting a new therapist. They were student therapists from the nearby medical school. I was apparently making progress with the one I saw during my senior year; she recommended that I continue my therapy after my allotted free sessions were up. For that, I had to tell my parents, but I only told them I was depressed.

    I think the student therapists I saw were reasonably good, after having professional therapists to compare them to. It turns out that I was very good at resisting efforts to get me to talk about things I couldn’t bring myself to talk about, But they were also inexperienced, and I was surely not the only one who couldn’t open up without a bit of prying. I don’t remember hearing complaints about the services offered, but I do remember being scared of possible consequences. Being forced to take time off school wasn’t one of them; having my parents find out was the main one. I think the fears were more from a complete lack of information than from campus rumors.

    The Harvard situation sounds worse than what I experienced at Rice, but if mental health were not stigmatized, students would have less to fear in getting help.

    And if mental health professionals were taught Stage 3 Energetic Literacy, even more people could be directed to the right treatments.

  30. 30
  31. 31

    DAVE, thank you for sharing a link to that article, which I read yesterday.

    The psychiatrist’s ideas are nuanced and informed by his work with patients who have — as he put it, had to choose for themselves, not just have him choose for them.

    It was poignant reading about patients who have had difficulty carrying out conversations with people because of the loud conversations going on inside their heads.

    I would like to do at least one phone session with such a patient, because some techniques of Rosetree Energy Spirituality might help some sufferers. Sometimes the 55-minute sessions have helped; sometimes I have seen an opportunity for Soul Energy Awakening Hypnosis to help, and hit has.

    All of us who facilitate energy transformation with mind-body-spirit are on the same team with the allopathic doctors and mental health professionals. I particularly admire the psychiatrist interviewed in the article you recommended.

  32. 32
    Katie says:

    Great article, I agree with psychiatrist Sandra Steingard, all people taking psychiatric medication would benefit from the lowest dose possible which provides benefit. Sometimes that means no medication at all.

    My guess is that mind-body-spirit energy transformation techniques like those of Rosetree Energy Spirituality would be extremely helpful for people with psychosis, if not for most anyone suffering psychiatric illness.

    Her ending statement in this article summarizes what should always occur in treatment decisions: “The point is that this is not a choice I should be making *for* my patients; it is a choice I need to make *with* them.”

    Everyone in need of care deserves such consideration. My hope is that anyone in need of psychiatric treatment finds a healing partnership with a psychiatrist or other health care professional, so they can explore treatment options that serve their best interest over time.

  33. 33
    Isabella says:

    Thanks for sharing that article, Dave. I really enjoyed it too. Here’s a picture of Dr. Sandra Steingard.

    http://www.7dvt.com/2013burlingtons-howardcenter-tries-new-approach-treating-mental-illness-more-talking-fewer-meds

  34. 34

    KATIE, thanks for this contribution.

    And ISABELLA, how wonderful to have this picture. Might you (or another Blog-Buddy) be interested in doing an aura reading or Skilled Empath Merge of Dr. Steingard?

  35. 35
    Katie says:

    Thanks for the pic Isabella, which led me to read the associated article. Although I am not skilled yet to do an aura reading or Skilled Empath Merge, I am so excited to read about Dr. Steingard’s work in Vermont! I will be avidly following her Open Dialogue program there. Also looking forward to an aura reading or Skilled Empath Merge should anyone with skills take up Rose’s suggestion here.

  36. 36
    Kira says:

    I finally got a chance to read the article. Awesome! I had a great-aunt with schizophrenia; I don’t know enough of the details of her medication history to know if different dosing would have helped her more, but she developed the condition late in life (or at least it showed up then), so she was atypical anyway.

    The article reminded me of the movie “A Beautiful Mind,” in which mathematician John Nash developed schizophrenia, lived with medication for a while, then figured out how to tell his hallucinations from reality and went off the medication.

  37. 37
    Kira says:

    I recently saw a video of a TED talk by a woman with schizophrenia who became a psychologist and also learned how to cope with her condition (in her case, voices) without medication. I will add the link if I can find it again.

    Ah, here it is:
    http://www.ted.com/talks/eleanor_longden_the_voices_in_my_head.html

    I found it very inspiring.

    I hope someday it will be easier to figure out who needs medication and how much, and what will help the others most.

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